It felt wrong to post a random blog topic on Easter, so here’s a detour investigating why some of my favorite Easter habits are now considered “no-nos”. Dying and hiding Easter Eggs, fuzzy chicks, and lots of chocolate – what could be wrong with that?

Salmonella Lurks in Eggs

Egg Egg Egg Egg. Photo by boughtbooks (Meagan)

I’m sure you know about egg safety – don’t eat raw eggs, refrigerate egg containing foods, etc. I don’t always follow the rules, despite knowing better. Luckily I’ve avoided infection so far. My rationale – cookie dough and hard-boiled eggs have been around forever! The warnings always seem a bit excitable on the part of public health (I know you’re cringing!). Personally, I need reasons for changing behavior. After investigating this post, I finally understand the excitement, and I promise to be good from now on. Here’s why.

Salmonella lurks in eggs. In the good old days, contamination occurred primarily when cracks allowed chicken feces to gain inside access. With clean uncracked eggs, the risk of infection was quite low. As a child, our Easter tradition consisted of dying hard-boiled eggs Saturday evening, leaving them out for the Easter Bunny to hide, and the kids searching for them on Easter morning. Average time without refrigeration – 12-18 hours (we threw away the hard-to-find ones that showed up a day or two later). For the next two weeks, we’d eat hard-boiled eggs every day. And we never got sick!

It turns out that salmonella changed the game beginning in the 1980s, and I never caught on. Instead of external contamination alone, salmonella started infecting chickens. Infected chickens don’t appear sick, but they lay eggs with salmonella INSIDE! No matter how clean the environment, contamination occurs internally before the shell even forms. Salmonella infected chickens are scattered everywhere in the United States and Europe. Luckily, infected chickens lay many normal eggs for each contaminated egg. The overall frequency of “bad eggs” is somewhere around 1 in every 15,000-20,000.

Hens from Egg Farm. Photo by Marji Beach.

The FDA Egg Safety Rule – Will It Help?

We can’t tell which chicken or egg has salmonella, so it’s not an option to just get rid of them. In 2010, the FDA issued an Egg Safety Rule. Most shell egg producers need procedures to prevent spread of salmonella, and must refrigerate eggs during storage and transport (although the rule doesn’t kick in until 36 hours after laying – a lot longer than the consumer 2 hour instruction). They must purchase hens from suppliers that test flocks for salmonella. If periodic egg testing shows salmonella, eggs from that flock must be pasteurized.

The problems: The regulations don’t cover all egg producers. Testing covers only the most common strain of salmonella in eggs, but other strains also cause human illness. The FDA already has trouble monitoring compliance – in many food-borne illness investigations, someone wasn’t following the rules. And none of these measures eliminate salmonella – if we are lucky, they might decrease it, but it’s way too soon to tell.

Egg Handling Rules

So whenever you eat an egg, it’s the luck of the draw whether it’s contaminated. Getting sick depends on how many bacteria are in the egg – the larger the number, the higher the odds. Salmonella is pretty tough, multiplying at temperatures from 40-140 degrees Fahrenheit. Keeping eggs refrigerated stops bacterial growth, but doesn’t kill them. Whenever the egg warms up, any salmonella inside will happily start replicating.

Purchase eggs from a refrigerated case (below 40 degrees).

No Easter Eggs (underlying photo by Matt Millard)

Purchase from a trusted vendor – were eggs refrigerated continuously from producer to store?

Check eggs to ensure they are clean and not cracked.

Refrigerate eggs as soon as you get home – maximum 2 hours out of the frig.

Don’t “incubate” eggs in the trunk on the way home – keep them in the passenger compartment.

Wash anything that comes in contact with eggs in hot, soapy water, and use separate cutting and preparation surfaces for eggs and poultry.

Use pasteurized egg products for raw egg recipes, including Caesar dressing, Hollandaise sauce, homemade ice cream or mayonnaise and cookie dough (both raw dough and under-cooked cookies). I’ll be looking into pasteurized shell eggs, a relatively new technology available from some stores.

Cooking kills salmonella, but it must be to firmness. No runny eggs allowed! For egg dishes, cook to at least 160 degrees throughout. Eggs also have lots of post-cooking recommendations. (Do infectious disease gurus believe a few bacteria survive despite cooking, or do they simply not trust us to cook thoroughly?)

Reheat cooked egg dishes thoroughly after refrigeration – no warming in the microwave.

Use hard-cooked eggs (in the shell or peeled) within 1 week after cooking.

When bringing cooked eggs on a picnic, or to work/school, pack them with ice (such as a frozen juice box in your lunch), and keep them out of the trunk or sun.

Caesar Salad. Photo by Cody and Maureen.

Eggs In Restaurants – Outbreaks Waiting to Happen

So that’s home egg use. But what about eating out, as Americans do 2-4 times a week? Unless your restaurant uses pasteurized eggs, the odds of infection increase. Restaurants often “pool” eggs – breaking all their eggs at once and mixing them together. Just one contaminated egg now infects the whole bowl. Add potential poor refrigeration, food handling errors, and inadequately cooked food – it’s amazing we don’t get salmonella from restaurants more often. (I keep thinking of omelet bars at hotel breakfasts!) Restaurants must post consumer advisories when using non-pasteurized eggs for under-cooked foods, but otherwise buyer beware. The tiny printed warning stating “consuming raw or under cooked meats, poultry, seafood, shellfish, or eggs may increase your risk of food-borne illness, really means “this restaurant probably doesn’t use pasteurized eggs – be cautious ordering egg dishes here”.

Ironically, salmonella outbreaks occur at hospitals and nursing homes. When food services cook eggs for many residents, you can be sure they pool eggs. In addition, both refrigeration and keeping food hot are problematic when delivering food to multiple patients simultaneously, many of whom don’t feel like eating when the food is served. Now add on the fact that the frail, elderly, and immunocompromised are most likely to get sick when exposed to salmonella. Pasteurized egg products or pasteurized in-shell eggs must be used for any under-cooked egg dish in these populations.

Poultry – Walking Salmonella Factories

Cute Baby Chicks! Photo by Open Gate Farm.

That’s eggs. But which came first – the chicken? Studies show up to 10 percent of broiler chickens test positive for salmonella worldwide (lower in the United States). Large or small, commercial or organic, free range or penned – salmonella and chicken farms often go together. Thank goodness raw chicken isn’t appetizing – cooking chicken kills salmonella, as long as internal temperature reaches 165 degrees throughout. The bigger problem is contamination of other foods – any utensil or surface touched by an uncooked chicken is suspect.

Even if chicken dinners aren’t part of your Easter celebration (my family eats ham), playing with cute fuzzy chicks might be. Think of poultry as walking salmonella playgrounds. Salmonella is shed in chicken feces. Mix in a little dirt, dry it, and before you know, salmonella is everywhere – nests, cages, fences, as well as feathers, feet, and beaks of every chicken in the yard. Add humans, and you get contaminated hands, shoes, and clothing.

Cute baby chicks may be covered in salmonella. If you touch them, or even their enclosure, consider hands contaminated. If you touch your mouth or eat, now you’re infected. The cure is GOOD HAND WASHING. Unless there’s a hand washing station next to the chicks, just cover your kids’ eyes and walk on by. Use hand sanitizers only when soap and water aren’t available. Supervise children during baby chick love sessions. Softness invites cuddling or kissing, which puts salmonella on clothes or faces – not solvable with hand washing. Children under 5 should not have contact with chickens – not only do they unconsciously put hands in mouths, but they are also more vulnerable to infection.

Chickens for Community Resilience

For those of you looking for the tie-in between salmonella and disasters, it’s raising chickens. I love the concept of small farm or backyard chickens – after all, community resilience is key for disaster survival. Unfortunately, free-range, organic, or small doesn’t mean salmonella free. In fact, salmonella infection and transmission may be higher in these environments. Possible contact with rodents and wild birds introduces salmonella to your flock. Close proximity between chickens and humans increases the likelihood of salmonella in your kitchen. By all means, keep backyard coops going. Just be extra cautious with food handling, raw eggs, and cooking.

Salmonella Illness – Living in the Bathroom

What if you break the rules (or are just unlucky) and get salmonella? You’ll join the estimated 1.2 million cases of food-borne salmonella every year in the US (140,000 from eggs). Want more company? Consider yourself a global citizen; joining over 1 billion salmonella cases a year – although the estimated global death toll of 3 million a year is disproportionately high compared to only 400 deaths a year in the United States. Access to medical care and safe food matters! Not all of these are from eggs and chickens – many other animals and foods do their part in salmonella transmission.

Salmonella will make you an unhappy camper, but you’ll survive, unless you are very old, very young, or have a weak immune system. After an incubation period of 12-72 hours, you’ll get vomiting, abdominal cramping, and diarrhea. It’s a lot like norovirus and other gastroenteritis infections, except salmonella causes fever, diarrhea can be bloody, and diarrhea lasts up to a week. For treatment, you just drink lots of fluids and tough it out. Antidiarrheal medications actually prolong the diarrhea – not a good choice with salmonella. Antibiotics don’t help standard salmonella in your gut. They just increase the time you’ll shed salmonella in your stools, and encourage antibiotic resistant strains.

In the elderly and frail, salmonella can spread to the bloodstream, with a fatality rate of 1-2/100. It also localizes in organs or joints, causing chronic disability. These situations require antibiotics and hospitalization. Small children with salmonella may become severely dehydrated and need intravenous fluids.

Safe Easter Traditions

Chocolate Bunnies and Easter Basket. Photo by Milo Tobin.

So what Easter traditions are safe? Bunnies! As far as transmitting illness, rabbits are one of the safest pets. They bite and scratch but rarely make you sick. Personally, I think they are cuter than chicks. Chocolate! Despite a recent recall of Nesquik Chocolate Powder for potential salmonella, chocolate is one of the safest foods in terms of food borne illness. So load up the Easter basket with chocolate bunnies. You might get fat, but at least you’ll be safe.

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Sheila Sund, M.D.

I am a physician from Salem, Oregon with a disaster fixation. Having left my previous specialties of neurology and hospice behind for now, I am instead focused on emergency preparedness, particularly healthcare response. Somehow the powers that be frequently forget that physicians will be an essential part of any response and recovery. I stick my head in everywhere to make sure we are included, and in the meantime, learn a lot about emergency response in general.
By Sheila Sund
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